In this study, we performed a cross-sectional survey to investigate the prevalence and stressors of job burnout for medical staff in Liaoning, China. We reported 72.9% of respondents experienced at least one symptom of burnout. This result is consistent with the previous studies . Numerous studies has already suggested that job burnout among doctors and nurses is a worldwide phenomenon23. Compared with the West, studies of burnout of medical staff in China were relatively limited. However, it is clear that Chinese medical staff also suffered with the high prevalence of burnout[8, 11, 12]. In our study, the prevalence of high burnout (high level in all 3 subscales) was 20.5%, which is much higher than another burnout study of Liaoning province (12.1% high burnout ) in 2013. The situation of job burnout in Chinese medical staff is still serious. Hospital administrator should be aware about the risk of burnout and efforts should be made to reduce job burnout among them.
In this study, we noticed that the percent of low PA was much higher than other survey in West countries . Similarly high percent of low PA also was found in another large survey for Chinese anesthesiologists (57% for PA) . The high percent of low PA in Chinese medical staff was a common phenomenon. It may due to relatively low income level and social reputation. Chinese medical staff often have to suffer with long training period, work overload, medical responsibility, pressure for promotion but get relatively low income. These resulted in a universal psychological gap among medical staff. Except that, dissatisfaction of patients also reduced social reputation for medical staff. All these lead to reduce personal accomplishment of Chinese medical staff.
Job burnout can be effected with factors of demographics and work situations[8, 10, 34, 35]. These demographics and work situations factors in our study explain variance in 6% EE, 5.2% variance in DP and 2.1% variance in PA. In our study, higher level burnout can be seen among respondents who were male, 30–39 years old, had master's degree or high education, and working hour > 60 hr per week. These respondents prone to experience workload and time pressure which are strongly related to burnout .
In this study, we performed a ranking survey to understand the respondents’ subjective perception about major stressors including work tasks, the relationship with patients, title promotion, the relationship with superiors, the relationship with colleagues, and work-family conflict. As the results, the relationship with patients and work tasks were the top two ranking stressors for Chinese medical staff (Fig. 2). That is consistent with our expectation that the relationship with patients and work tasks are the major stressors for burnout. We considered that our study reflected the true attitude for different stressors among Chinese medical staff.
In order to assess the stress from the relationship with patient which impact on job burnout, we used the scales for workplace violence (WVS) and fear of malpractice (FMS) in this study. Our results indicated that both WVS and FMS were significantly relative to the EE and DP burnout subscales. This is agreement with previous reports[15, 31]. The relationship with patient (WVS and FMS) explained 19.4% of variance in EE, 16.9% variance in DP and 2.0% variance in PA, respectively. For stress from work tasks, the ERI Questionnaire was a widely used measurement[17, 26]. In our study, the ERI subscales also had high correlations with EE and DP burnout subscales. The stress from work tasks (ERI) explained 23.9% of variance in EE, 16.3% variance in DP and 5.2% variance in PA, respectively. It is interesting that both in the ranking survey and the regression analysis, these two stressors had roughly equivalent scores. Our results suggested that these two stressors both are the major indicators for job burnout.
In China, due to the huge population and rapidly population aging, it creates increasing demands for medical care. Doctors and nurses have to face heavy work burden and longer working time, however, they have less time to communicate with patients. They have to increase their extrinsic effort to meet these changes. These combined effected strained the doctor(nurse)-patient relationship[9, 17] Strained relationship with patient caused increasing workplace violence and popular fear of medical malpractice among medical staff. Meanwhile, it exacerbates stress from work. All these cause medical staff easy to exhaustion, thereby lead to job burnout. Hospital administrators should pay more attention to the relationship of doctor-patient or nurse-patient and the status of work tasks to reduce job burnout.
Several limitations must be mentioned in the present study. First, the participants in this study were limited to 8 tertiary hospitals from 3 cities in Liaoning province, the representation of study population may not be complete. Second, due to this study used a cross-sectional design, it was not able to determine causality relationships. Third, our study based on a self-reported questionnaire, the reporting variance may affect the results of burnout and other factors in our study. Fourth, the relationship with patient issue was measured using WVS and FMS, which are indirect scales. These factors should be considered in the in-depth studies.